Cardio 26

Atrial fibrillation is treated with

with elective cardioversion or digitalis if the ventricular rate is not too slow.

A positive Kernig's sign

is an indication of meningitis.

The medication increases the force of the myocardial contraction.

A client with heart failure asks the nurse how dobutamine affects the body's circulation. What is the nurse's best response?

v-fib

A patient who had a myocardial infarction is experiencing severe chest pain and alerts the nurse. The nurse begins the assessment but suddenly the patient becomes unresponsive, no pulse, with the monitor showing a rapid, disorganized ventricular rhythm. What does the nurse interpret this rhythm to be?

0.04 second

Each small block on the graph paper equals

The nurse is providing discharge teaching with a client about pacemaker surveillance. Which client statement indicates a NO need for further teaching?

Pacemaker surveillance is painless, so there is no need to take any acetaminophen for the appointment. The surveillance can be done by transtelephonic transmission. The frequency of the surveillance appointments varies with each client. During the surveillance, battery life will be determined for client safety.

for bradycardia

Pacemakers are implanted

"The rhythm has a normal beat, then a premature beat pattern."

The client asks the nurse to explain what is meant by a ventricular bigeminy cardiac rhythm. What is the best response by the nurse?

pallor, nervousness, sweating, and faintness.

Premature ventricular contractions associated signs and symptoms include

ventricular depolarization.

The QRS complex represents ventricular depolarization.

A defibrillator

The licensed practical nurse is setting up the room for a client arriving at the emergency department with ventricular arrhythmias. The nurse is most correct to place which of the following in the room for treatment?

hypertension, dysrhythmias, pallor, and oliguria.

The side effects of vasopressor drugs are

Immediate bystander CPR

What is the treatment of choice for ventricular fibrillation?

QRS complex

Which ECG waveform characterizes conduction of an electrical impulse through the left ventricle?

the PR interval is

a component of an ECG tracing reflecting conduction of an electrical impulse through the AV node.

Premature ventricular contractions usually cause

a flip-flop sensation in the chest, sometimes described as "fluttering." Associated signs and symptoms include pallor, nervousness, sweating, and faintness.

Bigeminy is

a rhythm in which every other complex is a premature ventricular contraction (PVC).

Propranolol and other beta blockers

can interfere with conduction and the client should be evaluated for heart block. Propranolol has a desired effect of lowering heart rate, not tachycardia.

PVCs can be caused by

cardiac ischemia or infarction, increased workload on the heart (e.g., exercise, fever, hypervolemia, heart failure, tachycardia), digitalis toxicity, acidosis, or electrolyte imbalances, especially hypokalemia.

In trigeminy,

every third complex is a PVC. The rhythm is not regular and the rate should not be 150-250 bpm.

0.2 second.

five small blocks form a large block, which equals

A premature atrial complex (PAC)

is a single ECG complex that occurs when an electrical impulse starts in the atrium before the next normal impulse of the sinus node.

The QT interval

is an ECG characteristic reflecting the time from ventricular depolarization to repolarization.

view V4 electrode

is at the mid-clavicular line, fifth intercostal space.

view V3 electrode

is midway between V2 and V4.

view V2 electrode

is the left side of the sternum, fourth intercostal space.

The treatment goals for sinus tachycardia

is usually determined by the severity of symptoms and directed at identifying and abolishing its cause. The other interventions may be implemented, but determining the cause of the tachycardia is essential.

Causes of tachycardia include

medications that stimulate the sympathetic response, stimulants, and illicit drugs.

Cardiac rhythm refers to the

pattern (or pace) of the heartbeat. The conduction system of the heart and the inherent rhythmicity of cardiac muscle produce a rhythm pattern, which greatly influences the heart's ability to pump blood effectively.

Twiddler syndrome may occur

when the client manipulates the generator, causing lead dislodgement or fracture of the lead.

view V1 electrode

would be placed on the right side of the sternum, fourth intercostal space.

Question the client about alcohol and illicit drug use.

A 28-year-old client presents to the emergency department, stating severe restlessness and anxiety. Upon assessment, the client's heart rate is 118 bpm and regular, the client's pupils are dilated, and the client appears excitable. Which action should the nurse take next?

Twiddler syndrome Hiccupping Localized infection

A client asks the nurse about complications associated with use of a cardiac pacemaker. What does the nurse include in their response? Select all that apply.

inherent rhythmicity of cardiac muscle tissue.

A client asks the nurse what causes the heart to be an effective pump. The nurse informs the client that this is due to the:

supraventricular tachycardia

A client has a heart rate greater than 155 beats/minute and the ECG shows a regular rhythm with a rate of 162 beats/minute. The client is intermittently alert and reports chest pain. P waves cannot be identified. What condition would the nurse expect the physician to diagnose?

administer an IV bolus of atropine

A client has a medical diagnosis of an advanced first-degree atrioventricular block and is symptomatic. What initial treatment will the nurse be prepared to complete?

Double-check the monitoring equipment.

A client has been living with an internal, fixed-rate pacemaker. When checking the client's readings on a cardiac monitor the nurse notices an absence of spikes. What should the nurse do?

"Spike" on the rhythm strip

A client is unconscious on arrival to the emergency department. The nurse in the emergency department identifies that the client has a permanent pacemaker due to which characteristic?

Atrial flutter

A client presents to the emergency department via ambulance with a heart rate of 210 beats/minute and a sawtooth waveform pattern per cardiac monitor. The nurse is most correct to alert the medical team of the presence of a client with which disorder?

Failure to capture

A client receives a pacemaker to treat a recurring arrhythmia. When monitoring the cardiac rhythm strip, the nurse observes extra pacemaker spikes that don't precede a beat. Which condition should the nurse suspect?

"The small box will transmit the heart rhythm to the central monitor all the time."

A client with a second-degree atrioventricular heart block, Type II is admitted to the coronary care unit. How will the nurse explain the need to monitor the client's electrocardiogram (ECG) strip to the spouse?

a-flutter

A client's electrocardiogram (ECG) tracing reveals a atrial rate between 250 and 400, with saw-toothed P waves. The nurse correctly identifies this dysrhythmia as

PAC (Premature Atrial Contraction)

A healthy adult client is seeing a health care provider for an annual physical examination. While the nurse is taking the client's vital signs, the client states, "Occasionally, my heart skips a beat." The nurse believes that the client is experiencing what condition?

"I need to take a cardiopulmonary resuscitation (CPR) class now that I have an ICD."

A nurse has provided discharge instructions to a client who received an implantable cardioverter defibrillator (ICD). Which statement, made by the client, indicates the need for further teaching?

Clients with recurrent life-threatening tachydysrhythmias

A nurse is caring for a client who has been admitted to have a cardioverter defibrillator implanted. The nurse knows that implanted cardioverter defibrillators are used in which clients?

check the leads

A nurse provides evening care for a client wearing a continuous telemetry monitor. While the nurse is giving the client a back rub, the client 's monitor alarm sounds and the nurse notes a flat line on the bedside monitor system. What is the nurse's first response?

P wave P-R interval T wave

A nursing instructor is reviewing the parts of an EKG strip with a group of students. One student asks about the names of all the EKG cardiac complex parts. Which of the following items are considered a part of the cardiac complex on an EKG strip? Choose all that apply.

Call for emergency assistance if feeling dizzy. Record events that trigger a shock sensation. Avoid magnetic fields such as metal detection booths.

A patient has had an implantable cardioverter defibrillator inserted. What should the nurse be sure to include in the education of this patient prior to discharge? (Select all that apply.)

Lead wire dislodgement

A patient is 2 days postoperative after having a permanent pacemaker inserted. The nurse observes that the patient is having continuous hiccups as the patient states, "I thought this was normal." What does the nurse understand is occurring with this patient?

"The only difference is the heart rate."

The nursing student asks the nurse to describe the difference between sinus rhythm and sinus bradycardia on the electrocardiogram strip. What is the nurse's best reply?

More P waves than QRS complexes

The nurse expects to see which of the following characteristics on an ECG strip for a patient who has third-degree AV block?

Hypokalemia

The nurse identifies which of the following as a potential cause of premature ventricular complexes (PVCs)?

heart block

The nurse is administering propranolol to a client on a telemetry unit. What will the nurse monitor the client for?

pacer rate

The nurse is assessing vital signs in a patient with a permanent pacemaker. What should the nurse document about the pacemaker?

RR interval

The nurse is attempting to determine the ventricular rate and rhythm of a patient's telemetry strip. What should the nurse examine to determine this part of the analysis?

"This test will show any blood clots in the heart, and help us determine if it is safe to do a cardioversion."

The nurse is caring for a client scheduled for a transesophageal echocardiogram with a diagnosis of atrial fibrillation. The client's spouse asks the nurse to explain the purpose of the test. What is the nurse's best response?

"I should ask for a handheld device search when I go through airport security."

The nurse is caring for a client who is being discharged after insertion of a permanent pacemaker. Which question by the client indicates a need for clarification?

Elective cardioversion

The nurse is caring for a client with atrial fibrillation. What procedure would be recommended if drug therapies did not control the dysrhythmia?

"A transvenous pacemaker is used to manage transient bradydysrhythmias like those that occur during acute MIs."

The nurse is educating the client about a transvenous pacemaker. What is the best statement to explain why the client will have a transvenous pacemaker?

Atrial Flutter

The nurse is monitoring a patient in the postanesthesia care unit (PACU) following a coronary artery bypass graft, observing a regular ventricular rate of 82 beats/min and "sawtooth" P waves with an atrial rate of approximately 300 beat/min. How does the nurse interpret this rhythm?

Right side of sternum, fourth intercostal space

The nurse is placing electrodes for a 12-lead electrocardiogram (ECG). The nurse would be correct in placing an electrode on which area for V1?

Avoid MRI

The nurse is providing discharge instructions to a client after a permanent pacemaker insertion. Which safety precaution will the nurse communicate to the client?

"I will take acetaminophen prior to the appointment to lessen the interrogation pain."

The nurse is providing discharge teaching with a client about pacemaker surveillance. Which client statement indicates a need for further teaching?

Your family and friends may want to take a CPR class.

The nurse is proving discharge instructions for a client with a new arrhythmia. Which statement should the nurse include?

"The F waves are flutter waves representing atrial activity."

The nurse is speaking with a client admitted with a dysrhythmia. The client asks the nurse to explain the "F waves" on the electrocardiogram. What is the nurse's best response?

Heart rate of 42 beats per minute (bpm).

The nurse reads an athletic client's electrocardiogram. What finding will be consistent with a sinus bradycardia?

Defibrillator should be set to deliver a shock during the QRS complex.

The nurse recognizes which as being true of cardioversion?

"The client twiddles with or manipulates the generator or wires, causing the lead to fracture."

The nurse, along with a nursing student, is caring for a client who is admitted with a fractured pacemaker lead related to Twiddler syndrome. The student asks for information about Twiddler syndrome. The appropriate response by the nurse is which of the following?

Atrial flutter.

Which dysrhythmia has an atrial rate between 250 and 400, with saw-toothed P waves?

Monitor vital signs and cardiac rhythm

Which nursing intervention must a nurse perform when administering prescribed vasopressors to a client with a cardiac dysrhythmia?

The P wave is

an ECG characteristic reflecting conduction of an electrical impulse through the atria.

The automatic implanted cardioverter defibrillator (AICD) is

an internal electrical device used for selected clients with recurrent life-threatening tachydysrhythmias.

sinus Tach S/S

dilated pupils, restlessness, anxiety, and excitability can indicate illicit drug use (cocaine), the nurse should question the client about alcohol and illicit drug use

Defibrillation is used

for a ventricular problem.

The transesophageal echocardiogram will show

if the client has blood clots and help determine if it is safe to use cardioversion. The transesophageal echocardiogram does not indicate which area is causing the atrial fibrillation or the need to evaluate coronary arteries, as with a cardiac catheterization. Hypotension is diagnosed with blood pressure readings.

Complications associated with pacemakers include

infection at entry site, pneumothorax, bleeding and hematoma, hemothorax, ventricular ectopy and tachycardia, phrenic nerve/diaphragmatic(hiccupping)/skeletal stimulation, cardiac perforation, Twiddler syndrome, and hemodynamic instability.

A positive Babinski reflex is

normal in neonates, but indicates a central nervous system disorder in adults.